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Fu M, Zhu Y, Wei G, Yu A, Chen F, Tang Y, Wang Z, Wang G, Liu Q, Zhong C, Liu J, Zhong J, Tian P, Li D, Li X, Shi L, Guan X. Evaluation of pharmacist-led medication reconciliation at county hospitals in China: A multicentre, open-label, assessor-blinded, nonrandomised controlled study. J Glob Health 2024; 14:04058. [PMID: 38602274 PMCID: PMC11007753 DOI: 10.7189/jogh.14.04058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Background Due to a lack of related research, we aimed to determine the effectiveness of a pharmacist-led medication reconciliation intervention in China. Methods We conducted a multicentre, prospective, open-label, assessor-blinded, cluster, nonrandomised controlled study at six county-level hospitals, with hospital wards serving as the clusters. We included patients discharged from the sampled hospitals who were aged ≥60 years; had ≥1 studied diagnoses; and were prescribed with ≥3 medications at discharge. Patients in the intervention group received a pharmacist-led medication reconciliation intervention and those in the control group received standard care. We assessed the incidence of medication discrepancies at discharge, patients' medication adherence, and health care utilisation within 30 days after discharge. Results There were 429 patients in the intervention group (mean age = 72.5 years, standard deviation (SD) = 7.0) and 526 patients in the control group (mean age = 73.6 years, SD = 7.1). Of the 1632 medication discrepancies identified at discharge, fewer occurred in the intervention group (1.9 per patient on average) than the control group (2.6 per patient on average).The intervention significantly reduced the incidence of medication discrepancy by 9.6% (95% confidence interval (CI) = -15.6, -3.6, P = 0.002) and improved patients' medication adherence, with an absolute decrease in the mean adherence score of 2.5 (95% CI = -2.8, -2.2, P < 0.001). There was no significant difference in readmission rates between the intervention and control groups. Conclusions Pharmacist-led medication reconciliation at discharge from Chinese county-level hospitals reduced medication discrepancies and improved patients' adherence among patients aged 60 years or above, though no impact on readmission after discharge was observed. Registration ChiCTR2100045668.
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Affiliation(s)
- Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuezhen Zhu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Guilin Wei
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Aichen Yu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Fanghui Chen
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Yuanpeng Tang
- Department of Pharmacy, The First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Zining Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Guoying Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Qingpeng Liu
- Department of Pharmacy, The Peoples’ Hospital of Yudu County, Jiangxi, China
| | - Chunyuan Zhong
- Department of Pharmacy, The Peoples’ Hospital of Xingguo County, Jiangxi, China
| | - Jinghong Liu
- Department of Pharmacy, The First People’s Hospital of Longnan City, Jiangxi, China
| | - Jie Zhong
- Department of Pharmacy, The People’s Hospital of Ruijin City, Jiangxi, China
| | - Ping Tian
- Department of Pharmacy, The People’s Hospital of Shangyou County, Jiangxi, China
| | - Debao Li
- Department of Pharmacy, The People’s Hospital of Xinfeng County, Jiangxi, China
| | - Xixi Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Sibicky SL, Pogge EK, Bouwmeester CJ, Butterfoss KH, Ulen KR, Meyer KS. Pharmacists' Impact on Older Adults Transitioning To and From Patient Care Centers: A Scoping Review. J Pharm Pract 2024; 37:169-183. [PMID: 36062533 DOI: 10.1177/08971900221125014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Expand upon previous reviews conducted on transitions of care (TOC) services with a focus on pharmacist interventions for older adults specifically transitioning to and from long-term care, acute rehabilitation, residential care facilities, care homes, skilled nursing, or assisted living facilities, collectively termed patient care centers (PCC). Data Sources: A PubMed and Ovid MEDLINE search was conducted including citations between 1974 and July 14, 2022. Bibliographies were also reviewed for additional citations. Methods: Articles included described pharmacist interventions during TOC for patients transitioning to and from PCC, were written in English, and reported outcomes pertaining to TOC services. Of 873 citations reviewed, 22 articles met the inclusion criteria. Results: Most studies were prospective in design with small sample sizes, of limited duration, and with varying interventions and reported outcomes. Most explored the transition from hospital to PCC and included a pharmacist intervention involving the identification of medication errors and discrepancies during the TOC. Few studies reported cost savings or 30- and 60-day reductions in readmission rates or mortality. Conclusions: This scoping review revealed a lack of robust clinical trials to assess the effectiveness of specific interventions performed by pharmacists for patients transitioning to and from PCC. Of the available data, pharmacist involvement within an interprofessional team can be an effective intervention to resolve medication discrepancies, reduce readmissions, and medication-related adverse events. An opportunity exists for future studies to explore ways to improve outcomes during TOC within PCC.
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Affiliation(s)
- Stephanie L Sibicky
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | - Elizabeth K Pogge
- College of Pharmacy - Glendale Campus, Midwestern University, Glendale, AZ, USA
| | - Carla J Bouwmeester
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | | | - Kelly R Ulen
- Department of Geriatrics, UPSTATE Community Hospital, Syracuse, NY, USA
| | - Kristin S Meyer
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA
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Correard F, Arcani R, Montaleytang M, Nakache J, Berard C, Couderc AL, Villani P, Daumas A. [Medication reconciliation: Interests and limits]. Rev Med Interne 2023; 44:479-486. [PMID: 36841717 DOI: 10.1016/j.revmed.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/22/2023] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Admission to hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. The practice of medication reconciliation is securing for the patient because of the medication errors detected with significant clinical impact. Its implementation must comply with the recommendations of the French National Authority for Health (HAS) and its deployment is now integrated into the contract for improving the quality and efficiency of care (CAQES). However, although it allows to intercept medication errors, its impact on the length of hospitalization, the rate of readmission and/or death following discharge seems limited. Given the limited human resources to carry out this time-consuming activity, patient prioritization should be considered. Studies on the fate of patients and on the medico-economic issues are also necessary in order to make this activity sustainable.
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Affiliation(s)
- F Correard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - R Arcani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - M Montaleytang
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - J Nakache
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - C Berard
- Pôle pharmacie, unité d'expertise pharmaceutique et recherche biomédicale, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A L Couderc
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - P Villani
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France; Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital Sainte Marguerite, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique du PR Villani, hôpital de la Timone, Assistante Publique des Hôpitaux de Marseille (AP-HM), Marseille, France.
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Cheng C, Walsh A, Jones S, Matthews S, Weerasooriya D, Fernandes RJ, McKenzie CA. Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic. Int J Clin Pharm 2023; 45:293-303. [PMID: 36367601 PMCID: PMC9650667 DOI: 10.1007/s11096-022-01475-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.
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Affiliation(s)
- C Cheng
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK.
- Institute of Pharmaceutical Sciences and Institute of Psychiatry, Psychology, Neurosciences Kings College London, London, SE1 9RT, UK.
| | - A Walsh
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
| | - S Jones
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
- Institute of Pharmaceutical Sciences and Institute of Psychiatry, Psychology, Neurosciences Kings College London, London, SE1 9RT, UK
| | - S Matthews
- Pharmacy Department, Medway NHS Foundation Trust, Gillingham, ME7 5NY, UK
| | - D Weerasooriya
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
| | - R J Fernandes
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
| | - C A McKenzie
- Pharmacy Department, Kings College Hospital, London, SE5 9RS, UK
- Institute of Pharmaceutical Sciences and Institute of Psychiatry, Psychology, Neurosciences Kings College London, London, SE1 9RT, UK
- Pharmacy and Critical Care, University Hospital Southampton, Tremona Road, Southampton, S016 6YD, UK
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